Cost Analysis of Sirolimus-Eluting Stents in the Japanese Health Insurance System

概要

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The cost-effectiveness of drug-eluting stents (DES) has been evaluated in the United States and Europe, however, there is little information from Japan. The present study evaluated the cost-effectiveness of sirolimus-eluting stents (SES) in Japan. In-hospital and follow-up costs of 25 consecutive patients undergoing SES implantation in a de novo lesion were evaluated. A control group for comparison was composed of 25 consecutive patients undergoing bare metal stent (BMS) implantation in a de novo lesion before the introduction of SES. There was no significant difference in resource use between the SES and BMS groups. Procedural cost (¥1,049,200 ± 208,793 versus ¥896,590 ± 117,984, P = 0.01) was higher in the SES group than in the BMS group because of the higher reimbursement price of SES (¥378,000 versus ¥258,000). In-hospital cost (¥1,202,891 ± 208,793 versus ¥1,050,280 ± 177,984, P < 0.01) was higher in patients treated with SES. Less target lesion revascularization (4% versus 20%, P = 0.2) in patients with SES reduced the difference; aggregate 1-year cost was not significantly different (¥1,479,481 ± 284,343 versus ¥1,463,640 ± 495,803, P = 0.9). It is concluded that SES may be cost-effective even in Japan.